Erectile Dysfunction

Question 1

What is the definition of Erectile Dysfunction?

Answer 1

The inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance – NIH consensus conference on Impotence

Question 2

What is the physiological mechanism of erection?

Answer 2

Tumescence:
Parasympathetics –> NO synthase –> increased NO/cGMP –> decreased intracellular Ca–> smooth muscle relaxation –>
Arterial dilation –> increased intracavernosal pressure
–> compression of venous sinuses
–> decreased venous outflow –> erection

Question 3

What is the mechanism of Detumescence?

Answer 3

Detumescence:
Sympathetics –> NE –> alpha adrenergic receptors –> Phosophlipase C –> Increased inositol triphosphate –> increased intracellular Ca –> smooth muscle contraction –> detumescence

Question 4

What are the general categories of ED?

Answer 4

Vasculogenic
Neurogenic
Psychogenic
Endocrinologic
Medication induced

Question 5

What medications may cause ED?

Answer 5

Antihypertensives: beta-blockers, thiazides, clonidine, methyldopa,
Antidepressants: TCAs, MAO inhibitors, Li,
Antipsychotics: phenothiazines
Anti-testosterone: Cimetidine, Spironolactone,
Other: sedatives, phenytoin, anticholinergics, alcohol, tobacco

Question 6

What medical conditions may cause ED?

Answer 6

Chronic renal failure
Diabetes
Chronic liver failure
Alcoholism
Thyroid disease
Atherosclerosis/PVD

Question 7

What surgeries may cause ED?

Answer 7

Prostatectomy
Cystectomy
Proctocolectomy
Vascular surgery
Pituitary surgery
Penile surgery

Question 8

What trauma may cause ED?

Answer 8

Pelvic fracture
Perineal trauma
Penile fracture
Priapism
Spinal cord injury
Pelvic radiation

Question 9

What is CV risk in ED and what should you recommend?

Answer 9

Low risk: treat ED, safe for sex

• -Asymptomatic CAD
• -

Question 10

What is intermediate CV risk in ED?

Answer 10

> 3 CAD risk factors
Class III LVD
Stable angina
MI 2-8 weeks ago
Non cardiac atherosclerosis
Murmur of unknown significance

Refer for cardiovascular testing
Defer sexual activity till after testing
Reclassify after testing

Question 11

What is High CV risk in ED?

Answer 11

Unstable angina
Uncontrolled HTN
Class IV LVD
MI within 2 weeks
High risk arrythmia
HOCM
Moderate to severe valvular disease

Refer to cardiologist
Defer sexual activity till cleared by cardiologist